How India Succeeded The Impossible Task Of Polio Immunization

Commercial and Social Documentary Photographer Sandeep Biswas is the Edge of Humanity Magazine contributor of this social documentary photography. To see Sandeep’s body of work click on any image.

From the introduction of the book

” India’s Story of Triumph Over Polio“

Text © UNICEF

They said India would be the last country to stop polio.

The feat was near impossible: to find and immunize more than 170 million children behind every door of every dwelling in this vast sub-continent; to reach the millions who didn’t even exist on a map – brick kiln workers, construction workers, slum dwellers, nomads; to provide two drops of oral polio vaccine to protect India’s children from the most intense transmission of wild poliovirus on the planet, in one of the most heavily, densely populated countries on earth.

Primary School No.2, Pakwada, Moradabad, Uttar Pradesh – Polio Booth Activity day: A child is vaccinated during the SNID ( Sub National Immunization Day ). Photo Credit: Sandeep Biswas/ UNICEF

CMC Utsav, Tanushree farms, Ghaziabad, Uttar Pradesh – Nearly a Thousand CMC’s ( Community Mobilization Coordinators) from Uttar Pradesh gather together during a celebration organized by UNICEF to commemorate their endless hard work and commendable efforts towards a successful eradication of Polio in India. Photo Credit: Sandeep Biswas/ UNICEF

They said the population was just too large, and moved too much. Every year, 27 million babies were born – a large enough cohort on their own to sustain transmission, if not immunised. Every day, 23 million people criss-crossed the country on 11,000 passenger trains. They moved abroad too, carrying virus from India to other countries, resulting in outbreaks of Indian virus in Bangladesh, Nepal, Tajikistan, even Angola.

Kalyan Railway Station, Mumbai, Maharashtra- Polio Booth Activity day: A vaccinator of a transit polio vaccination team vaccinates children inside the trains. They travel between various stations to identify & vaccinate children who are in transit between cities and towns on the day of vaccination. Photo Credit: Sandeep Biswas/ UNICEF

Mumbai, Maharashtra-Polio Booth Activity day: A Booth monitor at Rafique Nagar, keeps a check on all vaccination records during distribution of the polio vaccination to the vaccinators at the Baingawadi health Post in Govandi.
Photo Credit: Sandeep Biswas/ UNICEF

They said the challenges were too great. The mixture of poor sanitation, population density, poor health conditions, heat and monsoon created a perfect storm for virus transmission. In western Uttar Pradesh, rumours swirled about the oral polio vaccine, that it was ‘haram’, that it sterilized boys and other theories that generated distrust. In neighbouring Bihar, the Kosi River flooded the plains each year, overnight turning green rice fields into a vast, inland sea. Here, the millions that farmed its edges left their homes, moving to new ground as they’d done for centuries, the completely new landscape rendering last year’s microplans useless, the vaccinators forced to traverse wide rivers on slow boats to find those scattered children. How could you possibly know if you had immunized them all?

Primary School No.2, Pakwada, Moradabad, Uttar Pradesh- Polio Booth Activity day: A group of boys hang around the Government school premises, which is also a vaccination booth, waiting to be served halwa ( An Indian sweet pudding made out of Semolina. Photo Credit: Sandeep Biswas/ UNICEF

Mumbai, Maharashtra- Polio House to House vaccination Day: A child, whose parents are migratory laborers from West Bengal, an eastern state in India is vaccinated by the house to house vaccination team, at the highly congested slums of Sangam Nagar. Photo Credit: Sandeep Biswas/ UNICEF

They said the epidemiology was a bridge too far: to raise immunity to the threshold required to stop the virus, experts said, more than 95% of children in India’s highest-risk areas would need to be vaccinated more than eight times each. That would require the Government of India to fund and distribute more than 90 million doses of oral polio vaccine every month, to coordinate and pay more than 750,000 vaccinators every month, and to outlay more than $500 million a year, every year, until it was finished. That would require the vaccinators and social mobilizers to roll out up to 10 campaigns a year. To march through Ghaziabad’s baking hot alleyways in May, or traverse the sweltering humidity of the Kosi River basin in August, to climb the ladders of Mumbai’s three-storey slums in December, to reach every construction site in Gurgaon and every brick kiln in Bihar, to seek out every last child in the microplan, to not be complacent, to not tire, or be lazy, or waver in the face of parents, shouting, “Why these polio drops again?”. It was not their stipend of just $1 a day, but the cause which kept the front line workers going.

Bhiwandi, Maharashtra-Polio Booth day Preparation: A group of school children rallying a day prior to the SNID ( Sub National Immunization Day) at the lanes of Handi compound area to spread the awareness about the importance of polio vaccination. They are accompanied by FTFV ( Fast Track Fied Volunteers). Photo Credit: Sandeep Biswas/ UNICEF

Rashid Nagar, Malegaon, Maharashtra – Polio House to House vaccination Day: A Vaccinator marks a house so that they keep a check on homes with Children under 5 years. The marking helps the Polio vaccination Teams to keep a tab on the children who have been vaccinated and children that got left out during the vaccination drive. Photo Credit: Sandeep Biswas/ UNICEF

In 1988, when the World Health Assembly, inspired by the success of smallpox eradication, embraced Rotary International’s dream of a polio-free world and launched the Global Polio Eradication Initiative, an estimated 350,000 children worldwide were paralyzed or killed by poliovirus each year. A staggering 200,000 of these cases occurred in India. What followed was the world’s largest immunization effort: twice a year, National Immunization Days reached more than 170 million children across the country in five days. A further seven to eight times a year, Sub-National Immunization Days reached nearly 75 million children in the highest-risk areas, the focus being to reach every child, in every round. This incredible endeavour was achieved through the strong commitment and partnership between the Government of India, the World Health Organization, Rotary International and UNICEF – the key polio implementing partners – as well as the US Centers for Disease Control and Prevention, CORE, the Bill & Melinda Gates Foundation, the US and Japanese government aid agencies, among others. It happened through the rigorous management of well-planned vaccination campaigns and an appetite for seeking innovative solutions to challenges; by focussing on the one child missed with equal passion as the 99 who were vaccinated.

Gayatri Nagar Health Post, Bhiwandi, Maharashtra- Polio Booth day Preparation: Marker pens and tally sheets are organized for the vaccinators at the center prior to the SNID ( Sub National Immunization Day ).
Photo Credit: Sandeep Biswas/ UNICEF

To reach every child, frontline workers mapped every village, town and city, every brick kiln and nomadic settlement via ground-level microplanning. Pregnant mothers and newborns were tracked and ‘due lists’ for vaccination shared with local health workers. Mobile vaccination teams cast a tight net for children at major intersections, at bus stations, on railway platforms and even on moving trains. Nomadic groups and sites were tracked, religious festivals followed, and human resources allocated to focus on the very highest-risk groups and areas. Tens of millions of children were vaccinated at border posts with Nepal, Pakistan and Bangladesh.